MY BIRTHDAY

Today is my birthday and I want to thank all of my good friends who have taken the time over the past few days to send me their good wishes. And also my thanks to all of you who have followed these chronicles of my 61st year. Best wishes to you all!

Just for the record, as the BW likes to say, here’s an up-to-date medical update.

My weight: In the wake of my lap-band surgery on May 31, I’ve lost a total of 105 pounds. From my top weight of 332, I now tip the scales at a much more manageable 228. It’s like not having to carry around a 100-pound person 24 hours every day.

My blood pressure was 110/75 last Friday.

My cholesterol was under 100 the last time I checked.

My diabetes has gone away. Although I have stopped taking all insulin and other diabetes drugs, my blood sugar levels remain perfect for a non-diabetic person. (A1C = 6.5)

I look and feel pretty good, I think. But I have to admit that there were moments during the past few weeks that I thought I might not make it to my birthday.

My leukemia has returned. But that was expected. I know CLL remissions aren’t forever. The disease is still incurable. But it can be managed for a long time with the proper care and attitude. And I’m very lucky to have a lot of both. Leukemia is easy. It’s the small infections – and bad medical advice that worry me at times.

I still have a chronic wound on my left shin that just refuses to heal or be diagnosed. At least that was true until last week. I now think we’ve turned the corner on this and it has begun to heal. I’ll be concentrating on that during the next few weeks.

Perhaps the following letter I sent to the administrator of the NYU’s Joint Disease Hospital will tell you what happened and save me regurgitating the whole episode again. (The actual names of the doctors have been removed for real and imagined legal reasons.)

March 16, 2009

Mr. David Dibner
Senior VP, NYUHJD Hospital Operations
301 East 17th Street
New York, NY 10003

Dear Mr. Dibner,

This note is being sent as an addendum to the Outpatient Programs Survey sent to Indiana. But I’d like to tell you about my experiences at NYUHJD during the past few weeks.

I like to think of myself as an informed patient who has learned to manage his own treatment during the past decade. Since I was diagnosed with type 2 Diabetes (1998) and Chronic Lymphocytic Leukemia (2003), I have chosen doctors affiliated with NYUMC to facilitate my treatment. Choosing Dr. K (endocrinology) and Dr. A (hematology / oncology) has been very satisfying to my family and me. This relationship was important to me in choosing Dr. F to perform gastric lap band surgery on me in May, 2008. Today I am 105 lbs lighter and free from diabetes thanks to my NYU experience.

Imagine how happy I was when, while researching doctors to treat a chronic wound on my left shin, I discovered that Dr. B, an expert in treating these wounds, was now affiliated with NYU. Imagine how disappointed I am after what happened next.

Even before I met Dr. B (at 3 pm on Feb. 20, 2009), my first experience with the doctor was to overhear him talk with an associate about an “operating room mortality” while standing outside the examination room where I waited. “I know you have to expect mortalities,” he said, “but …”

He walked into the room, took a quick look at my wound and quickly told me there was a “deep infection” that would have to be “abraded” during the first of a series of surgeries that might last six months to a year. He said there was a good chance the bone was involved in the infection. His Physician’s Assistant informed me the immediate therapy was to apply iodine soaked patches on the wound. As the first patch was being applied by an orderly, Dr. B reappeared and told me the iodine might “tingle or pop for a little while.” He then handed me his card, told me to call him on the phone at the hospital on Sunday “to talk,” and left.

Although everything I had read about chronic wounds said caregivers should quickly make sure to treat the patient’s pain to assure he would cooperate in treatments, none of my complaints about constant pain were addressed during my visit, and the doctor’s “tingle and pop” remark was the medical understatement of my year.

Our “talk” on Sunday was very short. Most of it involved the doctor trying to remember who I was. I asked him to call my endocrinologist and oncologist to tell them what was he was considering. He said he would.

All during the weekend, I felt uneasy about Dr. B’s proposed treatment. I called many of my friends in the medical profession and they all confessed to not understanding his approach. I even asked Dr. K, who I would -- and do -- trust with my life, to call Dr. B and tell me what her impressions were.

The pain from the iodine pads was considerable but I went ahead and applied the pads all week. The following Friday I visited the doctor again. Again, the receptionists and especially the orderlies all performed heroically. The RN who saw me prescribed Lidocaine patches to help with the pain from the iodine (“Put them on the wound for 12 hours, take them off and apply the iodine patch,” she said.)

Then a smiling Dr. B made a brief appearance. “Are we all happy here?” he asked.

I told him I was not happy, mainly because he had never returned Dr. K’s repeated calls during the week. “What’s her number?” he asked, pulling out his cell phone. I gave him her cell number, immediately got her on the phone and disappeared. About 45 minutes later, he told me he had spoken to her for a long time and had a much better idea of my medical “history” and my oft-stated desire to stay out of the hospital if at all possible.

“Two or three days -- two days, tops,” he promised about the surgery now suddenly scheduled for March 9. “He ordered me to get an MRI and pre-op tests during the week and said he would see me before the operation.

I still had my doubts and a nagging feeling something wasn’t right. “Can I ask you something?” I said. “Why haven’t you cultured the wound and started me on a wide-spectrum antibiotic?”

He said he needed a “deep biopsy” to get an accurate reading and somehow equated that with trying to avoid “indiscriminate use of antibiotics.”

I’ve spent half my life living that belief, long before it was accepted in the medical mainstream, I said, protesting: “But I’m infected now!” It didn’t make sense to me to wait trying antibiotics to control the infection. But before I could gather my thoughts, Dr. B had left.

Dr. Katz reported on her phone conversation with Dr. B. She said she understood my reluctance but didn’t think I had “any other options” but to go ahead with the surgery despite still feeling very uneasy.

I had the MRI Wednesday evening, March 4. The following day, I spoke to Dr. A who said he didn’t like the idea of starting such a surgical process because I was due for another round of chemotherapy to control my CLL. I asked him to speak to Dr. B, who still hadn’t contacted him. I then called Dr. B’s office and asked that they tell the doctor to return Dr. A’s calls. (I also had asked the RN to call me because the Lidocaine patches are not helping. When she called two days later she told me the directions she had given me were wrong and I should not put the patch directly over the wound.)

Dr. B and Dr. A finally talked late in the afternoon and Dr. A called me to report that Dr. B “was very insistent on going ahead with the surgery.” The MRI results still hadn’t been posted. Asked what I should do, Dr. A said I should postpone my pre-op physical and see him in the morning. The results were finally put into the computer system at 5:51 am on Friday. I saw Dr. A and he showed me the report. No bone involvement! Superficial cellulitis! No signs of any deep infections. Dr. A prescribed Levaquin and took a tissue sample to culture. Anticipating a round of chemotherapy, we scheduled a CAT-scan session for the following week.

By Sunday morning the pain was completely gone and the wound was making huge strides in healing itself. The culture came back as containing three different infectious organisms – enterobacter cloacae, paeudomonas aeruginosa and staphylococcus aureus – but all were responding to the Levaquin.

As you know, one thing all three germs have in common is that all are usually spread in hospitals. Whenever I think of how close I was to dangerous and needless surgery, I tense up.

One postscript: On Wednesday, Dr. B’s office called and asked if I wanted to reschedule the pre-ops and surgery. I asked if the doctor had seen the MRI report. “No, we don’t have it yet,” the secretary said.

“Let me get this clear,” I said. “The report was posted at 5:51 am last Friday and doctor still hasn’t seen it?”

“I guess I should print it out and fax it to him,” she said.

I guess so.

I am sorry this has gone on so long but I think it’s a cautionary story worth telling. I know how hard doctors work and how difficult their jobs are today and I am still proud to be an NYU patient and intend to be one for as long as possible.

If you do have any questions, please feel free to contact me. Thank you.

Yours truly,
Marc Kalech

I think all of this goes to prove what I said here a long time ago:

• Don't go in the hospital unless you absolutely have to.
• Learn about your disease and how to manage it -- even if it scares you.
• Take charge of your own care and treatment.
• Remember, you know as much -- or more -- than your doctor.
• Always! Always! Always, get a second -- or third -- opinion.
• Follow your instincts. Your informed, intelligent body probably knows more than anyone lese about what's wrong with you.

Happy Birthday. (And, please, many more.

WEEKEND AT BERNIES

Just got this photo and we've only glanced at the website that created it. It's a cool way to get traffic to a sales site. But the Mafia Nickname Generator is much cooler. It dubbed me Marc "The Squealer" Kalech.

THE PERSON I LOVE

First, some full disclosure: In New York, WCBS-TV’s (Ch. 2), chief political reporter, Marcia Kramer, does not use her real name, which is actually, legally, Marcia Kramer-Kalech. Marcia is married to me, Marc Kalech.

I’m still not sure how this happened – but I do know that sometime, somewhere I did something right to deserve the company of this woman.

Professionally, Marcia is an anachronism. In any sense of the word, she’s beautiful, which is a priority in today’s market. But she also the last of a breed – she knows how to do her job. She has actual sources, actually comes up with stories, gets them right, meets deadlines and does it all with a personal style that’s makes viewers believe what she says.

My father once described her perfectly – and said so before he even knew I had ever met her. “She’s a beautiful woman with a real head on her shoulders,” he admiredly said. As an aside, when I told my parents I was going to marry Marcia they said “Who?” I told them to turn to Ch. 2 where she was on the air. They didn’t believe me and they didn’t until I took her home with me and produced her body.

As competing street reporters on the 5 pm to midnight shift in Manhattan, we saw eachother often. I had such a crush. But I always thought Marcia was out of my league. An obscenely long time ago, I remember covering a Bar Assn. dinner in Terrace on the Park in Queens. Marcia was there, on the arm to a guy I took to be a retired judge. I still remember what she looked like, what she wore and the smile she gave me when she saw me. The result – she seemed to move even further away on my imaginary league scale.

I say today that Marcia is better looking than ever. TV news executives, ruled by ratings, cannot get past the studies they paid squillions of dollars for that concluded viewers make up their mind about on-air reporters in about half a second. And their decision is based almost entirely on their gut reaction to the reporter’s face.

But before she went into TV, Marcia was a very successful newspaper reporter. Print editors – at least old-fashioned ones – still hire journalists based on whether they’re persistant and clever enough to get their resumes noticed. The late Jerry Nachman (who once called New York Post reporters “the crash test dummies of American journalism”) also declared that newspaper reporting was the only profession that rewarded personality defects. A master of the sound bite, Jerry wasn’t right about everything, but he nailed those two.

Anyway, I’m hoping all this will convince her how much I love her. She is the reason I live. I love her more everyday. She makes me a better person. And I swear that I’ve happily devoted my life to making her’s better – and happier.

I admit it doesn’t hurt a bit that she’s a knockout. In full TV makeup, she’s stunning. But without any makeup at all – and with just an unstressed smile – she’s unforgettable. That's the way she will live in my heart forever -- and I want her to know that I will devote my life to making those smiles last forever. With the a great belief in the power of the web, I pray these words will live for all time.

I love you Marcia.

WHY BEES LIVE INSIDE YOUR HEAD

Here's an oldie but a classic. it was written in the early 70s by a great group, "The Firesign Theater." if you don't know who they are, ask your grandfather -- or download it from itunes damn it. I suggest you start with "I Think We're All Bozos on This Bus."

THE FIVE LIFESTYLES OF MAN

The five lifestyles of man in the future are, starting from top to bottom, though it's circular:

BERZERKER Clue to a Berserker: Anybody who's got a gun. Anybody in a lime-green car with eight-foot tires, called Demon or Barracuda. Any Army officer. Anybody in uniform. A Bobby is not a Berserker. But maybe he is because he carries his job, his badge. Most people who have jobs. There's a Berserker aspect to all of us. You can play softball with a Berserker. A Berserker doesn't always have to kill, but in the back of his mind, it's not a bad idea.

ZIPS are under the Berserkers. The archetypal Zip is the 1930's guy with the thin moustache. Zips have always been concerned with hair. We're exhibiting Zip tendencies in having rather fancily cut moustaches. We're all prone to these various aspects. There's a Zip in everyone's kip, is the World War I English expression. Zips love new products. Zips are often found inside new headphones. They've got zip, pep. Zzzzzip! Zip me up! Most actors are Zips. There's a category called Hip Zip, which David invented yesterday.

B.O.Z.O. is the Brotherhood of Zips and Others. Bozos are people who band together for fun and profit. They have no jobs. Anybody who goes on a tour is a Bozo. Why does a Bozo cross the street? Because there's a Bozo on the other side. It comes from the phrase “vosotros,” meaning others. They're the huge, fat, middle waist. The archetype is an Irish drunk clown with red hair and nose, and pale skin. Fields, William Bendix. Everybody tends to drift towards Bozoness. It has Oz in it. They mean well. They're straight-looking except they've got inflatable shoes. They like their comforts. The Bozos have learned to enjoy their free time - which is all the time.

BOOGIES. You see a bunch of Boogies around you. That's our lifestyle. There are more spades in this class than any other. But the world is changing. There are now getting to be a lot of spade Zips. And spade Bozos. Boogies don't differentiate between grass and alcohol. People who work in post offices are generally Boogies. They take it easy. They don't Zip. They're not Bozos because they don't clone. They boogie around rather than hanging around one another. They Boogie.

BEANERS The Beaners live outside the Law of Gravity. They have more color television sets than anybody in the world. They're always appearing either on or with your color TV. They watch themselves on color TV. Beaners are very concerned with their own refuse, which they leave piled up around their house, but always in use. They're always going to use it. Hundreds of old pickup trucks. All Indians are Beaners. They don't care. Why should they? Beaners can't tell lies. They fear no one. "Don't point your finger at me Daddy-o, I cut it off!" Pico and Alvarado are Beaners. We love the Beaners.

In the early 70’s, most youth were Bozo-like. That's why people got so upset when Berzerkers come into a Bozo gathering. 'Cause Bozos never do anything to anybody. Bozos keep having rock festivals. They create Marijuana free-areas. Grass has moved into Bozodom. The Berserkers and Zips run things now.

Q: Why does a Zip pay taxes?

A: Because he likes to fill out the forms.

Berserkers run things by telling you the Beaners are going to get you. Those desperate Beaners may strike at any time! All politicians are Berserkers.

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Update for the 90's:

During the late 70's the youth began drifting into ZIPness, with the disco-era, and the general populace, in definite BERZERKER mode, began the Reagan years....

The use by former PRESIDENT George Bush, referring to some other politicians as "Bozos" may not have been influenced by the FT, but it might as well have been. Bush himself, like most politicians, was a BERZERKER.

Clinton showed definite BOZO tendencies in the way that he CLONES, BOOGIEness with his non-inhaling experiments, ZIP ness with Cristophe, but to date only a few BERZERKER tendencies...

But remember: it's all cyclical!

---

AT LAST -- THE ANSWER TO THE QUIZ

The Quiz: Who is the one man most responsible for almost all the trouble in today’s troubled world? And the nominees are:

A) Osama bin Laden
B) George W. Bush, Jr., II, the younger
C) Allen Greenspan
D) Vince Lombardi
E) None of the above / All of the above

Readers were invited to vote electronically and even instructed how to submit write-in candidates – although they were also warned that any such votes would be incorrect. Still, surprisingly, not a single vote of any kind was recorded. Nevertheless, here’s the correct answer:

Vince Lombardi?

The coach who won the first Super Bowl? The guy the Super Bowl trophy is named after? The man is practically worshipped by almost every American. Truth is, he was ahead of his time but only an okay football coach (he had some good teams and some bad ones), a terrible businessman (he was fired by almost every team he coached) and, supposedly, a great leader of men. What was his secret to motivate those hard drinking, hard living and hard-headed men of his generation (please don’t forget that Richard Nixon has one of his greatest fans)? Well, Lombardi is most remembered for saying “Winning isn’t everything – It’s the only thing!” he didn’t actually say exactly that, but it was close enough.

If that lesson was only followed by athletes, all would have been alright. But sports became a billion dollar business and in short order, the lesson was taken up by businessmen (and women) and politicians all over the world. Suddenly, the ends really did justify the means. Fair play, sportsmanship and charity was what losers practiced. Profit officially became king.

It no longer mattered how you got it as long as it was yours. Gordon Gekko’s mantra of "greed" became reality. Money was more important than anything. It became “the only thing.” The customer was never right and it was stockholders who had to be appeased. George Bush never felt he had to justify his stolen 2000 "election."

And it started with Lombardi.

The world must be de-Lombardized! The sooner, the better. Unfortunately for many of my friends, right after we cleanse the greedy lawyers, politicians and businessmen, Yankee fans must be reeducated to see the errors of their ways. Monument Park has to be put back in the field of play where it belongs.